RAKTA AND RAKTAMOKSHANA
Raktam, Rudhiram, Asruk, Shonitam, Lohitam, Rohatam, Asram, Kshatajam.
Importance of rakta:
Rakta is stated to be the moola or root of the body, as it causes Dharan, hence it is known as Dhatu. Thus rakta needs to be cared of and well protected as it is as important as jeeva and it is one of the Pranayatana.1 Acharya Charaka says that shudha rakta is responsible for bala, varna, sukha and ayushya. Living creatures are endowed with strength, complexion, happiness and longevity due to shuddharakta. Rakta plays a vital role in the substance of élan vital. 2
Formation of Rakta:
The subtle liquid principle known as Rasa, while circulating in the body, when reaches yakrut, pleeha, attains red colour due to Tejus and will be known as Rakta, which keeps the bodily tissues in healthy condition.3
By the administration of proper regimen, with due regard to the place, time and habit, pure blood is formed in human beings.
Panchabhoutikata of rakta:
Human body is made up of five primordial elements such as earth etc. as all their attribute are present in the blood also, the attributes being fleshy odour, fluidity, redness, movement and lightness, represents Pruthvi, Jala, Agni, Vayu and Akasha respetively.4
Sthana of Rakta dhatu are Yakrut and pleeha.5
Rakta is anushna sheeta, madhura, snigdha, rakta in varna, guru, having visragandha and vidaha like that of pitta.6
Prakruta Rakta Karma:
Rakta dhatu bestows colour, nourishment to the Mamsa and also the life activities.
Vagbhata has mentioned only Jeevana as the pradhana karma of Rakta.7
Rakta Sara Purusha:
Individuals having excellence of Rakta are characterised by unctuous, red colour, beautiful dazzling appearance of the ears, eyes, fac,tongue, nose, lips, sole of the hands and feet, nails, forehead and genital organs. Such individuals are endowed with happiness great genius, enthusiasm, tenderness, moderate strength and inability to face difficulties.8
Causes of vitiation of Rakta:
Rakta aggravates by exciting agents of Pitta and by frequent intake of drava, snigdha, guru, constantly undergoing diwaswapna, krodha, atapasevana, shrama, abhigata, eating during digestion, incompatible items and intake of food when previous meal is already under digestion and other similar dosha
Before understanding about Dushtarakta, features of Shuddharakta are to be known.
SHUDDHA RAKTA LAKSHANA
Blood simulating Indragopa varna, not too thick and free from vivarnata/discolouration should be taken as normal.10 According to Vagbhata, slightly madhura and lavana, zneither sheeta or ushna, not coagulated, resembling lotus, indragopa insect, gold, blood of sheep or rabbit in colour are the characteristic properties of pure blood.11
Shuddha Rakta can be vitiated by any one of the doshas , exhibiting its feature either in its colour, consistency and clotting factor.
DUSHTA RAKTA LAKSHANA:
Vatadushta Rakta exhibit lakshanas like phenila/foaminess, aruna or Krishna varna, parushata, tanu, quick flow and decreased coagubility.12
The changes in blood vitiated by Pitta – neela, peeta, harita or shyava, visragandha/odour of raw meat, unpleasantness even to ants and flies and a decreased coagulability.12
The changes in Rakta vitiated by Kapha – the Rakta will be similar to Gairikodaka, Mamsapeshi, Snigdha, Sheeta, bahala, picchila/slimy, continue to bleed for longer duration.12
If Rakta gets vitiated by all the three doshas, then it looks like Kanjika, specially durgandhayukta.12
The following diseases occur due to the vitiation of blood, mukhapaka, akshiraga, putighrana, asyagandhika/foul odour from mouth, gulma, upakusa, visarpa, raktapitta, pramilika, vidhradhi, raktameha, pradara, vatashonita, vaivarnya, agnisada, pipasa, gurugatrata, daha, tiktamla udgara, specially of the diet and drink that are not properly digested, krodha, sammoha of buddhi, salt taste in mouth, sweda, shareeradaurgandhya, mada, kampa, swarakshaya, atiyoga of tandra and nidra, tamodarshana, kandu, kota, pidaka, kushta, charmakeela.13
Raktamokshana is considered one among Shodhana procedures. Raktamokshana means letting of blood which is mainly indicated in certain disease state especially when there is Raktadushti and also during physiologic function.
The term “Raktamokshana” comprises of two words, ie., ‘Rakta’ & ‘Mokshana’.
The word ‘Rakta’ means:
UÇeÉç MüUhÉå £ü: - coloured, dyed, tinged, painted, Red, crimson, blood red.
The word ‘Mokshana’ is derived from the root ‘moksha’ means ‘to relieve’ or ‘to let out’. Therefore letting out of blood is known as Raktamokshana.
The process of Raktamokshana can be traced back to Vedic period only and not beyond that. In the Koushika sutra of Athravaveda, references of Raktamokshana by leech application are to be found (Atridev, A.D.1960)
During the period of Buddha, this process was in regular practice, which could be easily understood from Pilindivachha, a patient of Buddha in whom he did Raktamokshana by Shringa for parvavata (Atridev, A.D1960)
Samhita period :
Sushruta, Vagbhata focused on the Raktamokshana in detail. In Sushruta Samhita and Ashtanga sangrahas, we get separate chapters on Siravyadha. Charaka, the celebrated physician of ancient school of medicine, also gives brief description on this topic.
Coming to Sangraha period, Bhavamishra and Sharangdhara have discussed Siravyadha vidhi, while describing the management of various diseases.
Bloodletting indeed represents one of the oldest human efforts on medicinal therapy. It is hard but a fact to believe that in 18th century when the doctors who could do nothing to the patients coming to them, were just drawing blood as much as possible from them, so that they would feel something was being done for them (Text book of Pathology, William Boyd 1970, p. 1097)
CLASSIFICATION OF RAKTAMOKSHANA:
Depending on various factors, the media used for bloodletting varies. In absence of specific media any one of above said can be used for the purpose.
In case of bloodletting being vitiated by Vata, Pitta and Kapha dosha, the blood should be let out by Shringa, Jalauka and Alabu respectively. In cases of vitiation by two/all the three doshas together, Siravyadha or Pracchanna are to be adopted for letting out the blood.15
Application of Shringa can bring out blood from an area of ten angulis around; Jalauka can suck from an area of one hasta, the Alabu from an area of twelve anguli, Pracchanna from an area of one anguli, while Siravyadha can purify the entire body.16
In deep seated pathology, Jalauka is preferable, in pindita rakta – Pracchanna is useful, in case of generalized vitiation of rakta – Siravyadha is advised and Shringa, Alabu if pathology is superficial/utthana.17
Indications for Raktamokshana:
Bloodletting as a method of treatment is indicated in Sotha, daha, paka, raktavarna, asruksruti, Vatarakta, kushta, vata diseases having severe pain, pani roga, slipada, blood vitiated with poisons, granthi, arbuda, apachi, ksudraroga, raktadhimantha, vidari, stanaroga, debility and heaviness of the body, raktabhishyanda, tandra, putigraha, putiasya, putideha, yakrutpliha roga, visarpa, vidradhi, pidaka, paka of karna, oshta, ghrana, vaktra, siroruja, upadamsa and raktapitta. In all diseases, bloodletting can be done either by Shringa, Jalauka or by Siravyadha.18
Contraindications of Raktamokshana:
In the following cases, bloodletting is contraindicated: Generalised swelling, swelling in debilitated persons, caused by sour diet and that in those suffering from Pandu, Arshas, Udara, Shosha and in Garbhini.19
Jalauka is one among Anushastra and it is a type of Ashastra Raktamokshana.
As water is their life, they are called as Jalauka.20
Raktaya, jaluka, jalaka, Jalauka, jalaragi, jalayuki, jalika, jalasika, jalajantuka, veni, jalaloka, jalookasa, jalawkasi, rakta payani, rakta sandamshika, tikshana, vamini, jalahjivani, raktapata, vedine, jala sarpini, jala soochi, jalatanou, Jalauka, jalapatatmika, jalika, jalaluka.(Shabdakulpa druma Vol II)
The Jalauka are of twelve types, six poisonous and the same numbers are non-poisonous.21,22
Table Showing classification of Jalauka
Savisha Jalauka ( Poisonous )
Nirvisha Jalauka ( Non-poisonous )
Raktamokshana procedure is carried out in 5 different methods.
Jalaukacharana:- It is the method of blood letting by using leeches.This is a simple procedure.
Prachanna:- Incising the diseased part with different instruments is called prachanna.
Sringa:- Impure blood is drawn with the help of cow's horn by applyig it over the incised area is called sringa.
Siravyadha:- Siravyadha is excising a particular blood vessel.
Alabu:-In this procedure dried bottle is used.first incision is made on the skin,then alabu is placed tightly.Before placing the alabu,a small cotton swab is ignited inside it.due to negative pressure the blood will flow to the surface.After the removal of 30-60ml blood ,alabu is pulled out and wound is covered with drugs to heal.